Maria Grazia Cagetti

The Use of Probiotic Strains in Caries Prevention: A Systematic Review

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the “Consolidated Standards of Reporting Trials” (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

This paper describes the dental health status of Italian 4-year-olds in 2004/2005 and analyzes the association between caries in preschool children and some background characteristics in children and parents. Caries was recorded according to WHO criteria. 5,538 subjects were examined. Information on the children’s and their parents’ social, behavioral, ethnic and demographic status was obtained through a series of closed questions. Bivariate analysis was performed to investigate the association between caries and background characteristics. The probability of being an extra zero for the dmfs index was estimated via the zero-inflated negative binomial regression model (ZINB). 78.4% (95% CI = 77.2–79.6) of the children were caries-free. The national mean dmfs index was 1.36 (95% CI = 1.15–1.57), ranging from 1.22 (95% CI = 1.03–1.42) in the Italian North-East to 1.73 (95% CI = 0.83–2.63) in the South section. Significant bivariate associations between caries experience and risk factors were observed for parents’ nationality (not Italian vs. Italian: p < 0.001), parents’ educational levels (low vs. high: p < 0.001), preterm birth (yes vs. no: p = 0.011), prolonged breastfeeding (≤13 months vs. >13 months: p = 0.038) and early tooth eruption (<6 months as reference: p = 0.004). Multivariable analysis (ZINB) showed that children with a low caries risk level had a higher probability of being an extra zero; in particular, children from fathers with a high educational level showed a probability of being an extra zero of 0.22. The results suggest a need to plan preventive programs to reduce oral health disparities among Italian preschool children, based on educational intervention with parents and children concerning oral health and caries prevention.

Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management. AIM To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases. METHODS One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report. RESULTS & CONCLUSIONS There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases.

National Pathfinder Survey of 12-Year-Old Children’s Oral Health in Italy

No recent data on the experience of caries among Italian 12-year-olds are available. In 2004, an epidemiological survey called ‘National Pathfinder among Children’s Oral Health in Italy’ was promoted and carried out. This study reports the actual oral health status of Italian 12-year-olds according to gender, residence area and geographical distribution. Clinical examinations were carried out from March 2004 to April 2005, according to WHO criteria, and included dental caries (decay at the dentinal lesion level) and Community Periodontal Index (CPI). 5,342 children (2,670 males, 2,672 females) were examined by 7 ad hoc calibrated raters. Dental caries experience was found in 43.1% (95% CI 41.8–44.4%) of the study population. The mean DMFT score was 1.09 (95% CI 0.98–1.21). Significant differences (p < 0.05) were observed among geographical sections for DT, FT and DMFT. An inverse relationship was observed between mean DMFT and gross national product per capita (p < 0.001). Gingival bleeding was observed in 23.8% of children, while 28.7% had calculus. Significant differences in CPI scores among sections were found throughout the sample in both males and females (p < 0.001). Over the past two decades, mean DMFT fell from over 5 to its present level, halving every decade; consequently, the recorded level of dental caries has become aligned with that in other Western European countries. Nevertheless, differences in DMFT values remain between children from different socioeconomic backgrounds.

Caries risk profiles in Sardinian schoolchildren using Cariogram.

Objective. The aim of our study was to assess the caries risk profile in a group of Sardinian schoolchildren and to compare the outcome with their history of caries. Material and methods. Using the computer-based program “Cariogram”, 957 subjects aged 7, 8, and 9 years were enrolled in this cross-sectional study. The children were examined to evaluate dmfs/DMFS and gingival conditions. Data on dietary and oral hygiene habits were collected and saliva was analyzed, including levels of mutans streptococci (MS) and lactobacilli (Lb). Based on the Cariogram profiles, the children were divided into five risk groups in accordance with “chance of avoiding caries”. Results. Almost 50% of the children had a low caries risk, while more than a quarter had less than 40% “chance of avoiding caries”. A significant linear trend between the five Cariogram categories and dmfs/DMFS was observed in the three age groups (p<0.001). Conclusions. The Cariogram risk profile showed strong correlations to the caries experience of Sardinian schoolchildren and that efforts to reduce caries risk are necessary.

Does Smoking Increase Risk for Caries? A Cross-Sectional Study in an Italian Military Academy

Background/Aims: Traditionally, tobacco is considered as part of the military culture. A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in a sample of Italian adults attending a Military Academy. Methods: Clinical examinations including dental caries and presence of bleeding at probing were carried out following WHO criteria. Related socio-behavioural factors were collected. Four calibrated examiners observed 763 subjects (men = 722; 94.6% and women = 41; 5.4%). Results: One of the 763 subjects did not declare the smoking status and was excluded from the analysis. Hundred twenty-six (16.5%) subjects claimed to have never smoked, 200 (26.3%) were coded as light smokers and 436 (57.2%) as heavy tobacco users. Statistically significant linear trend across the educational level (p = 0.03), self-satisfaction with the appearance of teeth and gums (p = 0.04) and dental check-up in the past 6 months (p = 0.02) was found among the 3 subgroups. Almost the entire sample showed caries experience (84.1%). Mean DS ranged from 0.6 in the nonsmokers subgroup to 1.1 in the heavy smokers. Differences among means were statistically significant for DS, DMFS and Significant Caries Index (p = 0.01, 0.04 and 0.03, respectively). The zero-inflated regression model showed that caries severity was significantly associated with smoking habit (p = 0.02), dental check-up in the past 6 months (p = 0.01), self-satisfaction with the appearance of teeth and gums (p < 0.01) and healthy gums (p = 0.04). Conclusion: Heavy smokers attending a Military Academy showed a higher prevalence of caries, confirming a correlation between the disease and tobacco use.

Effect of a Sugar-Free Chewing Gum Containing Magnolia Bark Extract on Different Variables Related to Caries and Gingivitis: A Randomized Controlled Intervention Trial

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≧105 CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC5.7 and AUC6.2) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC5.7 (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing.

Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children

BackgroundDuring the past decades, the prevalence of caries disease in the population of Western industrialized countries has decreased markedly. In children also, a reduction of dental caries experience has been reported by many authors. The aim of this paper was to evaluate the trend of dental caries prevalence in 12-year-old children living in the city of Sassari, (Italy), by five cross-sectional studies conducted in 1989, 1992, 1995, 1998 and 2004.MethodsIn all cohorts, dental caries (DMFT and SiC Index according to WHO indications), was measured. For each variable measured (DMFT and sub-indices, SiC Index), differences in proportions among the five cohorts during the fifteen years were tested using χ2-square test.ResultsThe mean DMFT index decreased from 4.3 ± 3.1 in 1989 to 0.8 ± 1.5 in 2004. The prevalence of untreated caries (DT) had a notable decrease between 1992 and 1995, increased slightly between 1995 and 1998 and had the greatest decrease in 2004. The number of filled teeth remains low. The percentage of caries-free children increased from 10% to 64%, whereas the percentage of untreated caries changed from 44% in 1989 to 62% in 2004. SiC Index decreased from 7.8 in 1989 to 3.9 in 2004.ConclusionOn the basis of the results of DMFT and SiC Index, caries experience has been reduced. The vigilance and the promotion of a higher standard of personal oral hygiene and dental check-ups are necessary to obtain an improvement of oral status in the future adult population and to reach the new WHO global goals.

Salivary mutans streptococci and lactobacilli in 9- and 13-year-old Italian schoolchildren and the relation to oral health.

Abstract The prevalence and levels of mutans streptococci (MS) and lactobacilli (LB) in saliva and its possible correlation with dental caries and periodontal conditions was investigated in 473 Italian schoolchildren, 9 and 13 years of age. A clinical examination and sampling of stimulated whole saliva was carried out in the school and oral health was assessed as DMFT and CPITN using the WHO criteria. The saliva samples were frozen in liquid nitrogen and after thawing, cultivated on selective media. To test the influence of cryopreservation, fresh samples from 20 subjects were cultivated. Thirty-five percent of the children were caries-free with a mean DMFT of 1.9 at the age of 13. The majority exhibited healthy periodontal conditions. Salivary MS and LB were identified in 52% and 21% of the children, respectively. The prevalence of MS was higher among the 13-year-olds than the 9-year-olds while no such difference was found regarding LB. There was a statistically positive relationship (P<0.01) between the levels of MS and LB and both were significantly correlated to caries (P<0.01). The correlation coefficient of microbial recovery between frozen and unfrozen samples was 0.99. In conclusion, the data provided cross-sectional information of a clear positive relationship between selected micro-organisms in saliva and caries in 9- and 13-year-old children in spite of a relatively low prevalence of the disease. The findings are discussed in a risk selection perspective.

Association between interdental plaque acidogenicity and caries risk at surface level: a cross sectional study in primary dentition.

BACKGROUND In schoolchildren the most commonly decayed primary teeth are molars affecting proximal adjacent surfaces especially. AIM To determine whether a more acidic plaque in response to sucrose challenge is detected in children with more carious lesions. DESIGN Plaque pH measurements, using the microtouch technique, were carried out in interproximal spaces between primary molars, in 157 high caries risk children (314 sites and caries status of the 628 proximal surfaces recorded). The area under the curve (AUC(5.7) and AUC(6.2) ) was analyzed. RESULTS The AUC(5.7) and the AUC(6.2) showed a statistically significant difference between plaque adjacent to proximal surfaces with or without caries. Differences for AUC(5.7) and AUC(6.2) were recorded between one decayed surface compared to two decayed surfaces (P<0.01) whereas a statistical significant difference was only observed for AUC(5.7) , when the areas under the curve were obtained near one decayed surface compared to two sound surfaces (P=0.04). CONCLUSIONS The higher acidogenicity of the dental plaque found in presence of a proximal carious lesion in primary maxillary molars represents an additional risk factor for the adjacent surface. This finding may help clinicians in treatment decisions.